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目的:探讨MRI对卵巢成熟畸胎瘤术前诊断价值及手术方式选择的指导意义。方法:回顾性分析经妇科手术治疗、病理诊断为卵巢成熟畸胎瘤58例,术前均行MRI扫描。采用自旋回波(SE)序列、快速自旋回波(FSE)序列、压脂序列、DWI序列扫描。常规行矢状面、横断面及冠状面扫描。结果:(1)病变位于右侧卵巢30例,左侧卵巢28例,双侧卵巢3例。(2)病变大小为1.2-16.7cm,边缘较清晰,形态多为类圆形。(3)病变为囊性或囊实性。其内成分多样,MRI信号显示混杂,脂肪成分MRI上T1W、T2W为双高信号,脂肪抑制序列为低信号;牙齿、毛发、软骨、纤维成分T1W、T2W为双低信号;肌肉、神经成分T1W、T2W为等信号。(4)病变小于10 cm,其内脂肪成分较多,无腹腔镜手术禁忌症患者行腹腔镜卵巢畸胎瘤切除术;病变大于10 cm,钙化、毛发等实性成分较少时,能耐受膀胱截石位,行阴式卵巢畸胎瘤切除术;病变大于15 cm,或病变较小但以钙化、牙齿、毛发等实行性成分为主,怀疑恶性卵巢畸胎瘤或者不能判断病变性质时行传统方式开腹卵巢畸胎瘤切除术。结论:MRI能较好显示卵巢畸胎瘤内部结构及成分,在临床手术术式选择方面具有指导意义。
Objective: To investigate the value of MRI in preoperative diagnosis of ovarian mature teratoma and the choice of surgical approach. Methods: A retrospective analysis of gynecological surgery, pathological diagnosis of mature ovarian teratoma in 58 cases, preoperative MRI scan. Spin Echo (SE) sequence, Fast Spin Echo (FSE) sequence, Lipid sequence, DWI sequence scan were used. Routine sagittal, transverse and coronal scan. Results: (1) The lesion was located in the right ovary in 30 cases, the left ovary in 28 cases and the bilateral ovary in 3 cases. (2) lesion size of 1.2-16.7cm, the edge is more clear, mostly round-shaped. (3) lesions cystic or cystic solid. T1W and T2W of fat composition were double high signal and fat inhibitory sequence was low signal. T1W and T2W of tooth, hair, cartilage and fiber were double low signals; muscle and nerve component T1W , T2W is equal signal. (4) Lesions less than 10 cm, more fat content, laparoscopic surgery without contraindications Laparoscopic ovarian teratoma resection; lesions greater than 10 cm, calcification, hair and other less substantive components, the ability to tolerate By the bladder lithotomy position, line vaginal ovarian teratoma resection; lesions greater than 15 cm, or lesions smaller but with calcification, teeth, hair and other active ingredients mainly suspected malignant ovarian teratoma or can not determine the nature of the lesion When the traditional way of open ovarian teratoma resection. Conclusion: MRI can better show the internal structure and composition of ovarian teratoma, which has guiding significance in the selection of clinical surgical procedures.